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Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 449 - 449
1 Sep 2009
Carbonell PG Fernández PD Ortuño JL Trigueros AP
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Spastic muscles show permanent contraction but also paradoxical muscular weakness. Compartmental muscular pressure in normal subjects oscillates between 0 and 5 mmHg.

To study compartmental pressure in the posterior superficial compartment of the leg in children with spastic paralysis, to identify its variations after a percutaneous tenotomy of the Achilles tendon, and to find any possible connection with arterial pressure or weight.

Twelve patients who had undergone a percutaneous tenotomy of the Achilles tendon were studied. Six of them were tetraplegic and three hemiplegic, with bilateral and unilateral tenotomies respectively. The following variables were taken into consideration: age, weight, systolic and diastolic arterial pressure and pressure of the superficial compartment of the leg, both pre- and post- tenotomy. The measurement of the compartmental pressure was taken using an automatic calibration monitor with an error of measure of ± 1 mmHg. Statistics: descriptive, non-parametric tests (Wilcoxon, Kruskall- Willis).

The average age was 9.3 years old, 11 in men and 7.5 in women. 89.5% of the total population was male and 10.5 % female. The average weight was 27.2 Kilograms, 28.1 Kg. in men and 20.5 Kg. in women. Systolic pressure was 94.1 mmHg and diastolic pressure 41.3 mmHg. Pre-tenotomy compartmental pressure was 12.1 mmHg and 7.9 mmHg post-tenotomy, decreasing 34.5 % (p= 0.08, N.S.). Systolic pressure had no relation to pre-tenotomy (r = −0.16) o post-tenotomy (r = −0.13) compartmental pressure. Diastolic pressure had no relation either (p =0.2 and r=−0.36), respectively. The pressure of the superficial compartment of the leg is higher than normal in spastic patients, decreasing, although not significantly, after a percutaneous tenotomy of the Achilles tendon is performed.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 453 - 453
1 Sep 2009
Carbonell PG Bustamante D Fernández PD Rivas J Llamas I
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The Acetabular Index and the Physeal Angle of the proximal femur are a radiographic assessment of the morphology of the acetabulum and the proximal physis, respectively. Their values to decrease with age and it remains unknown whether any correlation exists between them or if weightbearing has any influence. X-rays belonging to 30 infants (60 hips), 4 boys and 26 girls, were studied between 2003 and 2006, measuring the Acetabular Index (AI) and the Femoral Proximal Physeal Angle (PPA). Measurements were taken using a goniometer (error ± 1°). All the cases had ultrasound scans at 4 months of age, with alpha angles smaller than 50° (Graf type IIa) and cephalic coverage between 33% and 50%. Anteroposterior hip X-rays were taken at 3 months (pre-weightbearing) and 4–10 months (post-weightbearing). Statistics: t-Test and correlation.

The AI was 21.5° (19.5° boys, 21.8° girls) pre-weightbearing and 20.9° (20.8° boys, 21° girls) post- weightbearing. The PPA was 76.5° (75.9° boys, 76.6° girls) pre-weightbearing and 74.9° (75.5° boys, 74.8° girls) post-weightbearing. AI and PPA decreased pre- and post- weightbearing, 2′8% and 2′1% respectively. The decrease was considered significant in the PPA (p = 0.02), especially in girls (p = 0.009), and not significant in the IA. Differences were found between sexes: the AI increased in boys (+6.3%) and decreased in girls (−8.3%), and the PPA decreased in both boys (−0.5%) and girls (−2.3%). The side had no influence. No relevant correlation was found between AI and PPA, both pre- (r = − 0.15, p = 0.27) and post- weightbearing (r = − 0.24, p = 0.07).

We did not find any relevant correlation between IA and PPA values, neither previous to weightbearing, nor in the months after weightbearing occurs. The measured angles suffered a decrease after weightbearing but the only significant decrease was in the PPA.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 237 - 237
1 Mar 2004
Carbonell PG Verdú JV Martinez SS Sanchis R
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Aims: Study our experience and short term results using a mix of osteoconductive (HA) and osteoinductive (AGF) materials. Methods: From October 2001 until June 2002, we have treated bone defects in 9 patients. Seven male and 2 female. Mean age 10.4 years (range 4–18 years). Mean follow-up: 5.6 months (range 3–9 months). AGF was obtained after autologous blood centrifugation according to blood volume, knowing the patient height and weight (Nadler Score). AGF was obtained through previous concentrate of platelets and red cells, with a further concentration, reducing its volume to 1/3. 10 c.c. of thrombin (500 UI) and HA (500R) were added, just before applying it to the patient. Total surgery time for preparation AGF was 20–30 minutes. Clinical cases treated were: varus osteotomy in Perthes (1 case- 11%); curettage in osteomyelitis (2 cases- 22%); essential cyst, after conventional corticoid treatment failure (2 cases- 22%); forearm pseudoarthrosis (2 cases- 23%) and triple arthodesis by valgus pronated spastic foot (2 cases- 22%). We never use autologous iliac graft with AGF- HA. Results: We have obtained radiological and clinical consolidation in all bone defects after 3–4 months. Radiological success is not clear after 4 months in one of the osteomyelitis cases (12’5%). Conclusions: 1. The iliac graft harvest morbility is about 9.4%- 49%. 2. A 2nd approach is avoided in children and adolescents. 3. With the use of AGF- HA we avoid morbility, diseases transmission, reduced surgery time and offer an alternative to autologous grafting.